Providing patient-centred care as Medical Radiation Practitioners to children and young persons in out of home care.

Modern healthcare focuses on patient-centred care where patients' needs, beliefs, choices and preferences are valued and lead to better health outcomes. Children and young persons in out of home care (OOHC) require more health care services compared with children from similar social and economic backgrounds. Each state and territory government are responsible for statutory child protection in Australia. If a child is unsafe in their current environment, they may be removed and placed into OOHC where they have ongoing case management with either a government or non-government agency. Complex trauma is the prolonged and uncontrolled exposure to traumatic events, like those experienced by maltreated children. Complex trauma can create a toxic stress response that produces biological alteration to the developing brain and affects the lives of the child, other family members and their descendants. Children with complex trauma often do not have the ability to regulate their responses to stimuli, reacting to minor triggers with disproportionate reactions. Many of these children will present with challenging behaviours. Trauma-informed care is a method of service delivery that seeks to actively minimise re-traumatisation. Creating a safe space is an essential element of trauma-informed care. Children with a history of complex trauma have life experiences that may be re-lived in a healthcare setting. There are ethical and legal considerations like privacy, consent and mandatory reporting when dealing with children in OOHC. By practising trauma-informed care Medical Radiation Practitioners can minimise further trauma to one of the most vulnerable population groups in Australia.

Academic success of undergraduate nursing students.

Defining students' academic success can be challenging when perceptions about the qualities that define it differ. Little is known about these perceptions when it comes to nursing students and particularly when English is a second language (ESL). Larger numbers of international and ESL students are gaining entrance into nursing education programs. The study purpose was to identify ways undergraduate nursing students and particularly ESL students self-report academic success. Study findings showed statistically significant findings for perceived student success when students had a prior degree, they were at a higher academic course level in their program, and believed they communicated adequately. Faculty roles that affect students' perceptions of their academic success are described and areas where actions can be taken are suggested.

Moving to a culture of health.

The Robert Wood Johnson Foundation (RWJF) has called for the nation to consider ways to establish a culture of health. Disruptive changes in nursing education are needed, ones that enhance nurses' views of societal needs as the core of clinical practice. A culture of health will require leadership. This leadership needs to be similar to the ways early nurse leaders identified care gaps and acted in society's best interests. A radical transformation in students nurses' education, including the curricula, and content will be needed. This article raises questions and suggests ideas about the disruptive changes needed for education and practice. If nurses are to be full partners in building a culture of health then some traditions must be relinquished and new forward thinking perspectives about nurses' roles must be taken.

Rural families' interpretations of experiencing unexpected transition in the wake of a natural disaster.

Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.

Rural families' interpretations of experiencing unexpected transition in the wake of a natural disaster / As interpretações de famílias rurais sobre a experiência de uma transição inesperada depois de um desastre natural / Las interpretaciones de familias rurales sobre la experiencia de una transición inesperada después de un desastre natural

Abstract: Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.

Resumo: Os desastres naturais afetam populações em diversas regiões do mundo. Os impactos dos desastres podem incluir problemas de saúde e transtornos da vida familiar, levando potencialmente a uma transição inesperada. O objetivo do artigo é apresentar a experiência com transições inesperadas, entre famílias rurais que sobreviveram a um desastre natural. Realizou-se um estudo de caso com seis famílias com crianças e adolescentes numa área rural no Sul do Brasil, afetada por um desastre em 2008. Para a coleta de dados, utilizamos a observação participante, entrevistas narrativas, genogramas, eco-mapas e um instrumento chamado rotina de calendário. A análise dos dados revelou diferentes interpretações das famílias sobre as mudanças que resultaram do temporal, comparando a vida antes e depois do desastre. A perda do lar e de entes queridos, a migração, o desemprego e perdas agrícolas foram as principais mudanças associadas ao desenvolvimento de novas tarefas. As experiências de transição familiar depois do desastre revelaram que as perdas influenciaram a vida social, a rotina diária e a preservação dos valores culturais.

Resumen: Los desastres naturales afectan a poblaciones en diversas regiones del mundo. Los impactos de los desastres pueden incluir problemas de salud y trastornos de la vida familiar, llevando potencialmente a una transición inesperada. El objetivo del artículo es presentar la experiencia con transiciones inesperadas, entre familias rurales que sobrevivieron a un desastre natural. Se realizó un estudio de caso con seis familias con niños y adolescentes en un área rural en el sur de Brasil, afectada por un desastre en 2008. Para la recogida de datos, utilizamos la observación participante, entrevistas narrativas, genogramas, eco-mapas y un instrumento llamado rutina de calendario. El análisis de los datos reveló diferentes interpretaciones de las familias sobre los cambios que resultaron del temporal, comparando la vida antes y después del desastre. La pérdida del hogar y de los seres queridos, la migración, el desempleo y pérdidas agrícolas fueron los principales cambios asociados al desarrollo de nuevas tareas. Las experiencias de transición familiar después del desastre revelaron que las pérdidas influenciaron la vida social, la rutina diaria y la preservación de los valores culturales.

Does a Culture of Appalachia Truly Exist?

Some disagreement exists about whether an Appalachian culture exists. Common notions about Appalachia's people are tied to myths that disguise truths about those that claim a heritage tied to place. Living in the region is different from having multiple generations of ancestors and a family legacy associated with place. Conclusions suggest that cultural traits of some residents are recognizable as unique from others in the nation's mainstream, but they are not generalizable to all people living in the Appalachian region.

Where is family in the family nurse practitioner program? Results of a U.S. family nurse practitioner program survey.

Though recent progress in family nursing science can serve the family nurse practitioner (FNP) to intervene in the regulation of family health, whether those advances are taught to FNP students has been unclear. All 266 FNP programs in the United States were invited to participate in a survey to assess the content and clinical application of family nursing theories in the curriculum. The majority of FNP programs frame family as the context of care for the individual. Though FNP students receive a foundation in family nursing theory in core courses, they are not usually expected to use family assessment methods in clinical practicum courses or to plan interventions for the family as the unit of care. The authors challenge educators to consider family nursing science as an essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice.

Predictors of daily blood glucose monitoring in Appalachian Ohio.

OBJECTIVE: To determine factors contributing to successful diabetes self-management in Appalachia, as evidenced by daily blood glucose monitoring. METHODS: A telephone survey (N=3841) was conducted to assess health status and health care access. The current investigation is limited to the subset of this sample who report having diabetes (N=529). RESULTS: A multivariate logistic regression model established that having attended a diabetes education class (P<.01) was the most significant predictor of successful diabetes self-management. The inability to pay for care, demographic variables, and health risk indicators were not found to be significantly related to self-management. CONCLUSIONS: This study identifies the role of education in successful diabetes self-management for patients in the Appalachian region.

Family inclusion in diabetes education: a nationwide survey of diabetes educators.

PURPOSE: The purpose of this study was to investigate perceptions about family inclusion and support in diabetes self-management education. METHODS: Surveys were mailed to certified diabetes educators (CDEs) in all 50 states and the District of Columbia, with a return of 225 surveys. Descriptive and inferential statistics (eg, t test, analysis of variance, correlation, and chi-square) were used as appropriate. RESULTS: Levels of importance placed on family involvement in diabetes education were significantly related to the emphasis placed on family during CDEs' formal or preprofessional education. CDEs' formal exposure to family theory influenced perceptions of their knowledge about family and the frequency that family support was emphasized in self-management activities but was unrelated to perceptions of their skillfulness in educating family members. Diabetes educators' personal values of family support were significantly related to how frequently family members were asked to participate in formal diabetes education classes. CDEs perceived that they were meeting individuals' self-management needs significantly better than those of families. Regional differences did not appear to be a factor in how CDEs incorporated family in diabetes education. CONCLUSIONS: Diabetes educators without formal exposure to family theory may be overestimating how much they emphasize family support in diabetes education. Increasing formal education about the importance of family involvement in self-management behaviors could positively affect individual diabetes self-management outcomes.

Residence in a distressed county in Appalachia as a risk factor for diabetes, Behavioral Risk Factor Surveillance System, 2006-2007.

INTRODUCTION: We compared the risk of diabetes for residents of Appalachian counties to that of residents of non-Appalachian counties after controlling for selected risk factors in states containing at least 1 Appalachian county. METHODS: We combined Behavioral Risk Factor Surveillance System data from 2006 and 2007 and conducted a logistic regression analysis, with self-reported diabetes as the dependent variable. We considered county of residence (5 classifications for Appalachian counties, based on economic development, and 1 for non-Appalachian counties), age, sex, race/ethnicity, education, household income, smoking status, physical activity level, and obesity to be independent variables. The classification "distressed" refers to counties in the worst 10%, compared with the nation as a whole, in terms of 3-year unemployment rate, per capita income, and poverty. RESULTS: Controlling for covariates, residents in distressed Appalachian counties had 33% higher odds (95% confidence interval, 1.10-1.60) of reporting diabetes than residents of non-Appalachian counties. We found no significant differences between other classifications of Appalachian counties and non-Appalachian counties. CONCLUSION: Residents of distressed Appalachian counties are at higher risk of diabetes than are residents of other counties. States with distressed Appalachian counties should implement culturally sensitive programs to prevent diabetes.

Diabetes care: provider disparities in the US Appalachian region.

INTRODUCTION: Diabetes is a devastating and growing problem in the USA and throughout the world. Parts of Appalachia, especially the most rural and economically 'distressed' areas of the region, have disproportionately high levels of diabetes incidence and have had long-standing problems in healthcare access. PURPOSE: Little is known about the status of public health infrastructures and expertise available to address the diabetes epidemic, whether in Appalachia or elsewhere. This research examines the availability of professional diabetes care in Appalachia, including the economically distressed areas of the region. METHODS: A 2006 cross-sectional survey of healthcare providers in the Appalachian Region identified diabetes service needs and availability in Appalachian healthcare facilities. Survey data and socioeconomic data were combined as a means to assess intra-regional variation in service availability. RESULTS: Participants perceived that diabetes prevalence was growing in Appalachia and that they were seeing increasing numbers of persons with diabetes. Healthcare facilities in the region rarely employed specialized health professional providers and the expertise concerning diabetes in some clinicians may be limited. CONCLUSION: The current and growing diabetes problem in Appalachia underscores the need for appropriate diabetes services and health professionals acquainted with current standards in diabetes care. Such problems in Appalachia have long been identified and linked with insufficient healthcare resources. The identification of ways to assure that local clinicians have current knowledge of diabetes standards of care is warranted.

Diabetes education in the Appalachian region: providers' views.

INTRODUCTION: The aim of this study was to examine provider perceptions concerning the provision and accessibility of diabetes education, according to levels of economic distress and rurality throughout the US Appalachian region. METHODS: A questionnaire regarding diabetes education resources was developed and mailed to all Federally Qualified Health Centers (FQHC), health departments, and known certified diabetes educators (CDEs) in the Appalachian region. Diabetes education was examined according to historical economic distress, distressed/at risk (DAR) versus not DAR (NDAR). RESULTS: Diabetes education classes were offered equally across DAR and NDAR locations and most patients with diabetes had attended. The CDEs and physicians were less common in DAR compared with NDAR sites (adjusted odds ratios [aOR]=0.33 [0.13, 0.85] and 59.1 vs 166.9 per 100 000; p < 0.001). The DAR sites were more likely than NDAR sites to report transportation (aORs 2.19-4.94) as a problem for patients and insufficient staff (aOR=2.50 [1.20, 5.18]) as a problem for diabetes education programs. CONCLUSIONS: Although DAR areas functioned with fewer health professionals than NDAR areas, many of the barriers to providing education affected patients and health professionals in both DAR and NDAR areas.

Spirituality and its relationships with the health and illness of Appalachian people.

This article explores the ways spirituality intertwines with the health and culture of those living in the Appalachian region. Nursing has long considered the value of spirituality and faith, noting its complex connections with health and illness. Literature pertaining to spirituality, health, and the culture of those residing in the Appalachian region was reviewed. Although the review suggests that connections between spirituality and health exist, empirical evidence is limited, somewhat dated, and lacks viable conclusions relative to the diverse needs of the Appalachian population. Focused research that addresses strongly linked operationally defined variables is needed to strengthen the evidence for clarity about distinct applications to practice.

Thai Family Health Routines: scale development and psychometric testing.

The aims of the study were to develop and test the psychometric properties of the Thai Family Health Routines (TFHR) scale, a 70-item self-report questionnaire used to measure the health of Thai families through their routine behaviors in daily life. Development of the TFHR was based on the structural domains of Denham's Family Health Model. The TFHR scale was initially composed of 85 items and tested on 1,040 families living in the central region of Thailand. The confirmatory factor analysis, with an acceptable factor structure model, yielded 70 items aligned with six factors: self-care, safety and prevention, mental health behavior, family care, family caregiving, and illness care routines. The preliminary psychometric properties demonstrated that the TFHR scale had satisfactory internal consistency, criterion validity, and construct validity. The test results suggested that the TFHR scale has potential benefits for family and community nurses to assess Thai family health for both research and clinical purposes.

High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio.

UNLABELLED: CONTEXT/PURPOSE: There is an epidemic of obesity and diabetes in the United States, especially in economically at-risk populations such as rural Appalachia. This survey determined the self-reported prevalence of obesity, diabetes mellitus, and associated macrovascular complications in 11 rural counties of Appalachian Ohio. The impacts of lifestyle, cardiovascular risk factors, income, and access to medical care were also determined. METHODS: A telephone survey identical to the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was conducted. Surveys were collected from 3,927 randomly selected residents 18 years of age and older in 11 counties of Appalachian Ohio and compared to published aggregate Ohio and national 2004 BRFSS data. FINDINGS: The self-reported prevalence of diabetes (11.3%) was markedly higher in Appalachian Ohio counties surveyed compared to aggregate Ohio (7.8%) or national (7.2%) 2004 BRFSS data (P < .044). The prevalence of heart disease (7.6%) and stroke (4.1%) in these counties was slightly higher than aggregate Ohio or national 2004 BRFSS data. In persons with diabetes, the prevalence of heart disease was 2-fold higher (20.0%) and stroke 3-fold higher (11.4%) than among nondiabetics (P < .042) in the region and higher than aggregate Ohio and National 2004 BRFSS data. Lower-income levels and decreased access to medications and glucose monitoring supplies correlated with the increased risk for cardiovascular complications in this rural population (P < .042). CONCLUSION: The self-reported prevalence of diabetes mellitus and its associated macrovascular complications are much higher in rural Appalachian Ohio compared to aggregate Ohio and National 2004 BRFSS data.

Improving patient satisfaction by addressing same day surgery wait times.

Wait times in same day surgery can create added stress to patients who are already anxious. Perianesthesia nurses understand the importance of patient satisfaction as they continually return to the bedside, answer questions, and meet patients' needs. Nursing interventions to involve the patient and family can help decrease stress and dissatisfaction that occur when the patient is not updated about time changes. Defining quality care can be difficult when consumers and providers view things differently. Frequently, patients associate hospital stay satisfaction with the respect nurses demonstrate for their needs. Timeliness regarding surgical times is an important aspect when meeting consumers' care expectations. The purpose of this paper is to describe the problems patients might have with surgical wait times and to suggest ways to enhance patient satisfaction.

Structuring successful interventions in employee health programs.

This literature review explored common characteristics of successful health promotion interventions that have produced positive outcomes for the diverse populations studied. Health education interventions delivered in structured environments with quarterly monitoring produced the most positive outcomes. Interventions delivered to employees in a "team" format were as successful as interventions delivered one on one. Single disease- or health behavior-focused interventions were more successful than multifocused interventions. Review findings indicate that academic or consultant researchers may lend expertise to research methods and informed consent as employers create health promotion programs they wish to evaluate. Employers may find benefits in conducting health-related studies developed through partnerships or collaborations with academic researchers.

Diabetes care and education in rural regions.

PURPOSE: The purpose of this study was to examine what is currently known about diabetes education and care in rural geographical regions. Residents of rural areas are less likely to have access to health care providers, health insurance, or specialty care and are more likely to experience health care disparities as a result. Persons living in rural areas are likely to have greater burdens of chronic disease, including uncontrolled diabetes, and perceive their health as poorer than their urban counterparts. METHODS: A conventional literature review focused on type 1 and type 2 diabetes was completed using the search terms rural, diabetes, and education. The databases searched were CINAHL, EBSCO, Pub Med, and Medline. In all, 22 research articles that fit the inclusion criteria were identified. RESULTS: Findings indicated that diabetes education for rural regions can be enhanced by a focus on family, culture, interdisciplinary teams, and technology. CONCLUSIONS: Future rural research about diabetes care should carefully define rural, include gender-related studies that describe findings in terms of men and women, and focus on primary prevention.

Cultural perspectives concerning adolescent use of tobacco and alcohol in the Appalachian mountain region.

CONTEXT: Appalachia has high rates of tobacco use and related health problems, and despite significant impediments to alcohol use, alcohol abuse is common. Adolescents are exposed to sophisticated tobacco and alcohol advertising. Prevention messages, therefore, should reflect research concerning culturally influenced attitudes toward tobacco and alcohol use. METHODS: With 4 grants from the National Institutes of Health, 34 focus groups occurred between 1999 and 2003 in 17 rural Appalachian jurisdictions in 7 states. These jurisdictions ranged between 4 and 8 on the Rural-Urban Continuum Codes of the Economic Research Service of the US Department of Agriculture. Of the focus groups, 25 sought the perspectives of women in Appalachia, and 9, opinions of adolescents. FINDINGS: The family represented the key context where residents of Appalachia learn about tobacco and alcohol use. Experimentation with tobacco and alcohol frequently commenced by early adolescence and initially occurred in the context of the family home. Reasons to abstain from tobacco and alcohol included a variety of reasons related to family circumstances. Adults generally displayed a greater degree of tolerance for adolescent alcohol use than tobacco use. Tobacco growing represents an economic mainstay in many communities, a fact that contributes to the acceptance of its use, and many coal miners use smokeless tobacco since they cannot light up in the mines. The production and distribution of homemade alcohol was not a significant issue in alcohol use in the mountains even though it appeared not to have entirely disappeared. CONCLUSIONS: Though cultural factors support tobacco and alcohol use in Appalachia, risk awareness is common. Messages tailored to cultural themes may decrease prevalence.